Accidentally saw an out-of-network provider, ended up needing surgery and now the claim is being denied.

I have United Health Care insurance, but a specific policy that only has certain doctors in-network.

I accidentally saw an OB who was out-of-network. (Mid pregnancy I moved and thus changed practices.) When I scheduled the appointment, the clinic said they took my insurance (found out too late that they were not actually in-network).

I went to the appointment, and found out I had lost the pregnancy. The doctor advised me that 2nd-trimester losses can cause DIC (a clotting disorder that can result in hemorrhage) and that I needed a D&E immediately. Surgery doc called me within an hour (around 5pm) and got me in for surgery the next morning at 8am.

When I checked in for the surgery, they took my insurance card, said something about this being an emergency procedure (Which I only remember because it scared me) but said nothing about not being in-network. I was a hysterical mess due to losing another pregnancy, and was not thinking about insurance issues.

I had the D&E and everything went okay. I got a call from the OB clinic a week later saying they were out-of-network and asking what other insurance I had (I have no other insurance). Now the bills for the surgery are of course being denied as well.

I called United and they said to get documentation from the doctors saying it was emergent and that I had no control over where I got the D&E surgery. The initial OB gave me a letter saying it was "urgent." Still working on getting something from the surgeon.

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Just looking for any advice on this, or how to hopefully submit a successful appeal. Thank you in advance for any help.

submitted by /u/Yam-Effective
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